Unlocking Access to Health Care: A Federalist Approach to Reforming Occupational Licensing

Several features of the existing occupational licensing system impede access to health care without providing appreciable protections for patients. Licensing restrictions prevent health care providers from offering services to the full extent of their competency, obstruct the adoption of telehealth, and deter foreign-trained providers from practicing in the United States. Scholars and policymakers have proposed a number of reforms to this system over the years, but these proposals have had a limited impact for political and institutional reasons. Still, there are grounds for optimism. In recent years, the federal government has taken a range of initial steps to reform licensing requirements for health care providers, and these steps have the potential to improve access to health care. Together, they illustrate a federalist approach to licensing reform, in which the federal government encourages the states to reform their licensing regimes, while largely preserving states’ control over the system. These steps include: (1) easing federal licensing restrictions for health care providers in certain areas where the federal government possesses regulatory authority; (2) creating incentives for states and professional bodies to experiment with reforms; (3) intensifying the Federal Trade Commission’s focus on licensing boards’ anti-competitive conduct; and (4) generating additional pressure for state-level reforms through expanding health insurance and promoting delivery system reforms under the Affordable Care Act. This article argues that a federalist approach represents the most promising path toward reforming occupational licensing in health care. Federal intervention in licensing is necessary, due to states’ lack of incentives to experiment with licensing reforms, the externalities of their licensing regimes, and their inability to resolve their own collective action problems. Nevertheless, large-scale federal preemption of state licensing laws is unlikely, due to a combination of interest group politics, Congress’s tendency toward incrementalism, and its reliance on the states to administer federal policies. A federalist approach also has functional advantages over outright federal preemption: it allows for more experimentation in constructing new licensing regimes, and it enables the federal government to take advantage of states’ institutional expertise in regulating occupations. Finally, this approach presents a model for how the federal government can play a constructive role in occupational licensing in other fields besides health care, and in other areas of state regulatory policy

Uncovering the minor contribution of land-cover change in upland forests to the net carbon footprint of a boreal hydroelectric reservoir

Hydropower in boreal conditions is generally considered the energy source emitting the least greenhouse gas per kilowatt-hour during its life cycle. The purpose of this study was to assess the relative contribution of the land-use change on the modification of the carbon sinks and sources following the flooding of upland forested territories to create the Eastmain-1 hydroelectric reservoir in Quebec’s boreal forest using Carbon Budget Model of the Canadian Forest Sector. Results suggest a carbon sink loss after 100 yr of 300,000 ± 100,000 Mg CO2 equivalents (CO2e). A wildfire sensitivity analysis revealed that the ecosystem would have acted as a carbon sink as long as <75% of the territory had burned over the 100-yr-long period. Our long-term net carbon flux estimate resulted in emissions of 4 ± 2 g CO2e kWh−1 as a contribution to the carbon footprint calculation, one-eighth what was obtained in a recent study that used less precise and less sensitive estimates. Consequently, this study significantly reduces the reported net carbon footprint of this reservoir and reveals how negligible the relative contribution of the land-use change in upland forests to the total net carbon footprint of a hydroelectric reservoir in the boreal zone can be

Biases in the perception of self-motion during whole-body acceleration and deceleration

International audienceSeveral studies have investigated whether vestibular signals can be processed to determine the magnitude of passive body motions. Many of them required subjects to report their perceived displacements offline, i.e., after being submitted to passive displacements. Here, we used a protocol that allowed us to complement these results by asking subjects to report their introspective estimation of their displacement continuously, i.e., during the ongoing body rotation. To this end, participants rotated the handle of a manipulandum around a vertical axis to indicate their perceived change of angular position in space at the same time as they were passively rotated in the dark. The rotation acceleration (Acc) and deceleration (Dec) lasted either 1.5 s (peak of 60 • /s 2 , referred to as being " High ") or 3 s (peak of 33 • /s 2 , referred to as being " Low "). The participants were rotated either counterclockwise or clockwise, and all combinations of acceleration and deceleration were tested (i.e., AccLow-DecLow; AccLow-DecHigh; AccHigh-DecLow; AccHigh-DecHigh). The participants' perception of body rotation was assessed by computing the gain, i.e., ratio between the amplitude of the perceived rotations (as measured by the rotating manipulandum's handle) and the amplitude of the actual chair rotations. The gain was measured at the end of the rotations, and was also computed separately for the acceleration and deceleration phases. Three salient findings resulted from this experiment: (i) the gain was much greater during body acceleration than during body deceleration, (ii) the gain was greater during High compared to Low accelerations and (iii) the gain measured during the deceleration was influenced by the preceding acceleration (i.e., Low or High). These different effects of the angular stimuli on the perception of body motion can be interpreted in relation to the consequences of body acceleration and deceleration on the vestibular system and on higher-order cognitive processes

Élaboration et validation d'un outil de dépistage des déficits du fonctionnement exécutif /

La présente recherche a été subventionnée par l'Association des collèges privés du Québec dans le cadre du programme de recherche et d'expérimentationBibliographie

Enjeux et solutions pour la sylviculture intensive de plantations dans un contexte d'aménagement écosystémique

Les plantations forestières représentent un outil sylvicole reconnu pour assurer un approvisionnement en matière ligneuse qui répond aux attentes de la société envers l'aménagement durable des forêts. Toutefois, elles font aussi partie du scénario sylvicole qui a le plus grand potentiel d'artificialisation de la forêt naturelle. Les objectifs de la sylviculture intensive de plantations peuvent alors paraître, de prime abord, en contradiction avec ceux de l'aménagement écosystémique. Nous décrivons le processus par lequel nous avons défini et documenté des enjeux associés aux plantations et proposé des pistes de solutions pour que la sylviculture intensive de plantations puisse s'intégrer à l'aménagement écosystémique. Nous avons identifié des enjeux relatifs à l'ampleur, à la localisation et à l'agencement spatial des plantations, aux attributs clés et à la résilience de la forêt naturelle, à l'acceptabilité sociale, ainsi qu’à la productivité et à la rentabilité des plantations. Nous avons également proposé des pistes de solutions qui permettraient de réaliser les plantations dans un contexte d'aménagement écosystémique, telles que la modulation des traitements sylvicoles pour augmenter la naturalité des plantations, la réalisation des traitements de manière à obtenir la production attendue, ainsi qu'un déploiement dans le paysage qui intègre les préoccupations des parties prenantes et qui considère la naturalité de la matrice forestière. Forest plantations are recognized as a silvicultural tool for ensuring a timber supply that meets public expectations regarding sustainable forest management. However, they are also part of the silvicultural scenario that shows the greatest potential for the artificialization of natural forests. From a firsthand perspective, intensive plantation silviculture objectives may appear antagonistic to those of ecosystem management. Here we describe the process through which we defined and documented plantation issues, then propose potential solutions to allow the integration of intensive plantation silviculture into ecosystem management. We identify issues related to the scale, localization and spatial arrangement of plantations, the key attributes and resilience of natural forests, social acceptability, and the productivity and profitability of plantations. We also propose potential solutions likely to help manage plantations within a context of ecosystem management. These include modulating silvicultural treatments to enhance the naturalness of plantations, conducting treatments to obtain expected production rates, and ensuring that plantations are deployed across the landscape in a manner that integrates stakeholder concerns and considers the naturalness of the forest matrix

Cardiorespiratory fitness is associated with physical literacy in a large sample of Canadian children aged 8 to 12 years

Background The associations between cardiorespiratory fitness (CRF) and physical literacy in children are largely unknown. The aim of this study was to assess the relationships between CRF, measured using the 20-m shuttle run test (20mSRT), and components of physical literacy among Canadian children aged 8–12 years. Methods A total of 9393 (49.9% girls) children, with a mean (SD) age of 10.1 (±1.2) years, from a cross-sectional surveillance study were included for this analysis. The SRT was evaluated using a standardized 15 m or 20 m protocol. All 15 m SRTs were converted to 20mSRT values using a standardized formula. The four domains of physical literacy (Physical Competence, Daily Behaviour, Motivation and Confidence, and Knowledge and Understanding) were measured using the Canadian Assessment of Physical Literacy. Tertiles were identified for 20mSRT laps, representing low, medium, and high CRF for each age and gender group. Cohen’s d was used to calculate the effect size between the low and high CRF groups. Results CRF was strongly and favourably associated with all components of physical literacy among school-aged Canadian children. The effect size between low and high CRF tertile groups was large for the Physical Competence domain (Cohen’s d range: 1.11–1.94) across age and gender groups, followed by moderate to large effect sizes for Motivation and Confidence (Cohen’s d range: 0.54–1.18), small to moderate effect sizes for Daily Behaviour (Cohen’s d range: 0.25–0.81), and marginal to moderate effect sizes for Knowledge and Understanding (Cohen’s d range: 0.08–0.70). Conclusions This study identified strong favourable associations between CRF and physical literacy and its constituent components in children aged 8–12 years. Future research should investigate the sensitivity and specificity of the 20mSRT in screening those with low physical literacy levels

Green Edge ice camp campaigns : understanding the processes controlling the under-ice Arctic phytoplankton spring bloom

The Green Edge initiative was developed to investigate the processes controlling the primary productivity and fate of organic matter produced during the Arctic phytoplankton spring bloom (PSB) and to determine its role in the ecosystem. Two field campaigns were conducted in 2015 and 2016 at an ice camp located on landfast sea ice southeast of Qikiqtarjuaq Island in Baffin Bay (67.4797∘ N, 63.7895∘ W). During both expeditions, a large suite of physical, chemical and biological variables was measured beneath a consolidated sea-ice cover from the surface to the bottom (at 360 m depth) to better understand the factors driving the PSB. Key variables, such as conservative temperature, absolute salinity, radiance, irradiance, nutrient concentrations, chlorophyll a concentration, bacteria, phytoplankton and zooplankton abundance and taxonomy, and carbon stocks and fluxes were routinely measured at the ice camp. Meteorological and snow-relevant variables were also monitored. Here, we present the results of a joint effort to tidy and standardize the collected datasets, which will facilitate their reuse in other Arctic studies

Efficient Production of HIV-1 Virus-Like Particles from a Mammalian Expression Vector Requires the N-Terminal Capsid Domain

It is now well accepted that the structural protein Pr55Gag is sufficient by itself to produce HIV-1 virus-like particles (VLPs). This polyprotein precursor contains different domains including matrix, capsid, SP1, nucleocapsid, SP2 and p6. In the present study, we wanted to determine by mutagenesis which region(s) is essential to the production of VLPs when Pr55Gag is inserted in a mammalian expression vector, which allows studying the protein of interest in the absence of other viral proteins. To do so, we first studied a minimal Pr55Gag sequence called Gag min that was used previously. We found that Gag min fails to produce VLPs when expressed in an expression vector instead of within a molecular clone. This failure occurs early in the cell at the assembly of viral proteins. We then generated a series of deletion and substitution mutants, and examined their ability to produce VLPs by combining biochemical and microscopic approaches. We demonstrate that the matrix region is not necessary, but that the efficiency of VLP production depends strongly on the presence of its basic region. Moreover, the presence of the N-terminal domain of capsid is required for VLP production when Gag is expressed alone. These findings, combined with previous observations indicating that HIV-1 Pr55Gag-derived VLPs act as potent stimulators of innate and acquired immunity, make the use of this strategy worth considering for vaccine development

Induction of Selective Blood-Tumor Barrier Permeability and Macromolecular Transport by a Biostable Kinin B1 Receptor Agonist in a Glioma Rat Model

Treatment of malignant glioma with chemotherapy is limited mostly because of delivery impediment related to the blood-brain tumor barrier (BTB). B1 receptors (B1R), inducible prototypical G-protein coupled receptors (GPCR) can regulate permeability of vessels including possibly that of brain tumors. Here, we determine the extent of BTB permeability induced by the natural and synthetic peptide B1R agonists, LysdesArg9BK (LDBK) and SarLys[dPhe8]desArg9BK (NG29), in syngeneic F98 glioma-implanted Fischer rats. Ten days after tumor inoculation, we detected the presence of B1R on tumor cells and associated vasculature. NG29 infusion increased brain distribution volume and uptake profiles of paramagnetic probes (Magnevist and Gadomer) at tumoral sites (T1-weighted imaging). These effects were blocked by B1R antagonist and non-selective cyclooxygenase inhibitors, but not by B2R antagonist and non-selective nitric oxide synthase inhibitors. Consistent with MRI data, systemic co-administration of NG29 improved brain tumor delivery of Carboplatin chemotherapy (ICP-Mass spectrometry). We also detected elevated B1R expression in clinical samples of high-grade glioma. Our results documented a novel GPCR-signaling mechanism for promoting transient BTB disruption, involving activation of B1R and ensuing production of COX metabolites. They also underlined the potential value of synthetic biostable B1R agonists as selective BTB modulators for local delivery of different sized-therapeutics at (peri)tumoral sites